Female Infertility Testing: Getting Started

Female Infertility Testing: Getting Started Female Infertility Testing: Getting Started

Tired of waiting month after month for a positive pregnancy test? It may be time to see a reproductive endocrinologist (RE).

An RE is a fertility specialist devoted to helping you conceive. If you see an RE, here is an overview of what you can expect when you start the fertility test process.

The workup
Before your first fertility test, your doctor will get a thorough medical history from you. He or she may ask you about sexually transmitted disease (STD) exposure and any previous pregnancies or miscarriages.

A physical exam and transvaginal pelvic ultrasound will follow. Your doctor will be checking to see whether you are ovulating or not, to best plan your course of treatment.


If you have been having regular periods that last between 26 and 32 days, for 6 months or more, your doctor may assume that you are still ovulating.

If your doctor is unsure about your ovulation status, he or she may do a blood test on day 21 of your menstrual cycle to check your progesterone levels. If this fertility test is inconclusive, your doctor may do an ultrasound of your ovarian follicles to check for ovulation. Ovulation problems can be a common cause of infertility.

Ovarian reserve

If your doctor determines that you are ovulating, he or she will want to evaluate your ovarian reserve. This can help your doctor determine your ovarian follicle (egg) health, which along with your age, plays a huge role in whether you will be able to get pregnant. Results of the ovarian reserve tests can also help your doctor determine whether you need to consider egg donation or additional fertility tests from a reproductive endocrinologist.

Ovarian reserve testing may include one or more of the following fertility tests:

If you are 38 or older, or have unexplained infertility, your doctor may want to a CCCT, which includes the following steps:

  1. On cycle day 3, your doctor will draw your FSH/E2 levels.
  2. On cycle days 5 through 9, you will take 100 mg of clomiphene citrate each day.
  3. Your doctor will draw an FSH level on cycle day 10.

After observing your FSH levels on cycle days 3 and 10, your doctor will determine the best course of action for you, and how aggressive fertility treatment needs to be.

Tubal health

If you are ovulating, your reproductive endocrinologist will want to confirm tubal patency with a hysterosalpingogram. After your period ends, and before you ovulate, your doctor will inject fluid into your uterus. An X-ray of your uterus will show whether your uterus and fallopian tubes are in good health or need additional fertility testing or treatment.


If you are not ovulating (anovulation), here are some fertility tests that your doctor may recommend:

  • An ultrasound test to determine the thickness of your endometrial lining and whether ovarian cysts are present
  • An endometrial biopsy if your uterine lining is thicker than it should be
  • Tests of FSH, luteinizing hormone (LH), prolactin, thyroid-stimulating hormone (TSH), DHEA-sulfate, and testosterone levels

These tests can shed light on any reasons for anovulation. Your doctor may also look for the following symptoms that can accompany anovulation:

  • Absence or presence of goiter
  • Abnormal secondary sex characteristics
  • Acanthosis nigricans (abnormally thick, dark skin growth)
  • Excess hair growing on the face and body
  • Nipple discharge
  • Turner's stigmata
  • Reproductive tract abnormalities
  • Striae (stretch marks)

Insulin resistance
Insulin resistance can also accompany anovulation, and is linked with a fertility problem called polycystic ovary syndrome (PCOS). Your doctor may check for the following symptoms of insulin resistance:

  • High levels of male hormones
  • Inverted FSH/LH ratio
  • Male pattern hair growth
  • Obesity
  • Ovarian cysts
  • Acanthosis nigricans (abnormally thick, dark skin growth)

If you show signs of insulin resistance, you will need to undergo a 2-hour glucose tolerance test, including blood draws of glucose and insulin levels. If your insulin to glucose ratio is abnormal, your doctor may recommend that you lose weight or start taking metformin. You may be sent to a reproductive endocrinologist for follow-up. Treatment for insulin resistance can be effective in helping women with PCOS ovulate and become pregnant.

Female infertility and age

Since age plays an important role in whether you can get pregnant, it is important to seek fertility testing as soon as you suspect any fertility problems. The guidelines on when to seek fertility testing are as follows:

  • Women under 35 should seek help if pregnancy is not achieved within 12 months of regular, unprotected intercourse.
  • Women over 35 should seek help if pregnancy is not achieved within 6 months of regular, unprotected intercourse.

This content is Copyright The American Fertility Association (AFA) 2010. This content is intended for personal use and may not be distributed or reproduced without AFA consent. Please contact info@theafa.org or visit theafa.orgfor more information.